I was diagnosed 05/10 with 3B lung cancer- NSCLC due to results of pleural effusion. I have undergone chemo only - Avastin for 1 yr., Abraxane for 1 yr, and now taking Tarceva 150 and my CEA #'s started to rise so doctor ordered Cat scan - I have had one as recent as 10/12. To make a long story short, this latest scan report shows no growth in past 2 years, no longer any lymph node involvement and said "possible misdiagnosis". We're going to keep me on Tarceva for another month and check to CEA to see if it's still climbing and then do a PET. A PeT was done in the very beginning and the lung and lymph nodes were quite lit up.
I would like another Oncologist's opinion about the radiologist's comment and if what wer're doing seems correct. My doctor is wanting to make sure there is no spread even if we haver the tumor and lymph nodes under control.
Reply # - March 18, 2013, 05:28 PM
Reply To: Cat Scan Question
Hi nancyj,
It's great to hear that there has been no growth over the course of two years. I think the first thing to be said about the radiologist's report is that those reports tend to be written in a bit of a vacuum - although the radiologist will look at previous scans, they do not have any of the other information about your case so they often make statements which reflect their limited knowledge.
It's also unclear what is meant by "possible misdiagnosis". If lung cancer cells were found in fluid drained from your pleural effusion, that points very clearly to a diagnosis of Stage IIIb "wet" lung cancer (now called Stage IVa). If on the other hand your tumor or lymph nodes were biopsied and lung cancer cells found and you were staged IIIb merely because of the existence of a pleural effusion, that might be a different story since other conditions can cause an effusion.
I'm not a medical professional but if cancer cells were detected in your pleural effusion, then continuing treatment and rescanning certainly seems reasonable.
JimC
Forum moderator
Reply # - March 18, 2013, 05:34 PM
Reply To: Cat Scan Question
nancyj,
You might also want to take a look at Dr. West's post on serum tumor markers such as CEA, as they do not always provide an accurate measure of cancer activity: http://cancergrace.org/lung/2007/06/16/tumor-markers-in-lung-cancer/
JimC
Forum moderator
Reply # - March 18, 2013, 09:34 PM
Reply To: Cat Scan Question
I think it would be unwise to just blindly speculate on what's going on without seeing all of the evidence directly, so I think it would be most helpful for you to consider a second opinion from someone, preferably with a specific focus in lung cancer, to offer additional thoughts. As Jim noted, if there was clear proof of cancer in the pleural fluid, then there really shouldn't be doubt about a misdiagnosis. Unfortunately, sometimes the radiology reports can take on greater weight than is justified if people forget that the people writing them actually don't care for any patients directly and only look at images with insufficient context to make broad interpretations. This typically makes radiologists appropriately circumspect about making any inferences about bigger questions, which is probably the wise approach for them.
-Dr. West
Reply # - March 19, 2013, 08:01 AM
Reply To: Cat Scan Question
Thank you so much for your rapid responses. One more question - Is it possible for a PET to show lit up areas and have tham not be cancer? That is what has my oncologist confused about the radiologist's comment about misdiagnosis since my PET showed such highlights.
Reply # - March 19, 2013, 09:18 AM
Reply To: Cat Scan Question
Yes, PET scans show uptake for reasons other than cancer, such as inflammation. I would expect that your diagnosis was based on more than just areas lighting up on a PET and the existence of a pleural effusion. Usually the diagnosis would come only after cancer cells were identified from a biopsy, surgical resection or testing of pleural fluid. Do you know what the basis of your diagnosis was?
You can read all about PET scans here: http://cancergrace.org/cancer-101/2010/09/14/cancer-101-faq-primer-on-p…
JimC
Forum moderator
Reply # - March 19, 2013, 09:49 AM
Reply To: Cat Scan Question
The basis was the pleural effusion - I think it took about 10 days for the diagnosis after it was drawn.
Reply # - March 19, 2013, 11:58 AM
Reply To: Cat Scan Question
Perhaps the radiologist is misunderstanding the situation. ?
This is a very informative post on MPE including links to blog posts. http://cancergrace.org/topic/malignant-pleural-effusion
I hope this is helpful,
Janine
Reply # - March 19, 2013, 01:18 PM
Reply To: Cat Scan Question
Again, thanks to all of you for your thoughts. This is becoming quite a learning experience for me and I'm grateful to you for it.
It would appear that what my oncologist is doing - keeping me on treatment another month and then having me have another Pet is appropriate. I feel good and have no aches or pains anywhere. I also have had no ill effects from all the chemo - never nauseated and some constipation is all, so I know I have been truly blessed with all of this for what will be 3 years in May. But I think he is wanting to see if cancer shows up anywhere else in my body.
Is it at all possible that the Avastin and Abraxane and now Tarceva have rid me, or at least put me in remission from the cancer?.. It appears for sure that at least my lymph nodes are now clear.
Again, thanks, and I appreciate all responses.
Reply # - March 19, 2013, 04:12 PM
Reply To: Cat Scan Question
It's absolutely possible that you've had a very good response to this treatment and you're now "N.E.D", short for "no evidence of disease", which is a great status to have after treatment. We generally don't use the term "remission" for solid tumors like lung cancer, but it's just an issue of semantics, instead favoring the term NED, but it's just as good.
-Dr. West
PS: Your oncologist's plan makes good sense to me.